Shoulder + Elbow Injuries Flashcards
What is subacromial impingement ?
What often causes
Pain and dysfunction due to decreased volume of subacromial space or increased contents
e.g. swollen bursae or increased bone e.g. after injury
Often due to rotator cuff injury
What are the symptoms of subacromial impingement
Painful arc in abduction - 60-120 (rotator cuff tear = pain up to 60)
Initially pain free
Pain hanging washing up etc
May subside when end of arch reached
How do you treat subacromial impingmenet
NSAID
Steroid injection
Physio
Arthroscopic decompression
What is frozen shoulder / capsulitis and what is worse movement
Very acute shoulder pain Passive and active affected All movement affected External rotation worse than internal / abduction Then becomes stiff Gradually over 2 years ROM returns
How do you diagnose frozen shoulder?
What other tests to exclude
X-ray is normal
Exclude other causes - BG, TFT
Passive no better than active
Passive better if rotator cuff tear
What causes frozen shoulder / RF
Idiopathic Trauma Periods of immobilisation F>M DM / thyroid issues / cervical spondylosis
How do you Rx frozen shoulder
NSAID / analgesia
Steroid injection EARLY
Early physio
Surgery if late
What causes rotator cuff tear
Trauma in younger
Degeneration of supraspinatous
Repetitive lifting
Athletes
What are the Sx rotator cuff tear
Pain not settling physio Crepitus Weakness Worse on abduction up to 60 Tenderness over anterior acromion
How do you Dx
USS sows tear
MRI show muscle wasting
What Is rotator cuff tear until proven otherwise
Pain not settling with physiology
How do you Rx
If acute / complete = surgical referral
Tears >2cm = surgical
Local steroid injection
What are rotator cuff muscles and role and where do they attach
Supraspinatous
Infraspinatous
Teres minor
Subscapularis
Stability of shoulder
Hold humerus against glenoid when deltoid abducts so may not be able to abduct even if deltoid fine
SIT = greater tuberosity of humerus Subscapularis = lesser tuberosity
What does supra do and what nerve
aBDucts with deltoid
Suprascapular nerve
Commonly injured as between aromion
What does infra do
Rotates laterally / external rotation
Suprascapular nerve
What does Teres do
Adducts
Rotates laterally / external rotation
Axillary
What does subscapularis do
Adducts
Rotate medially / internal rotation with pec major
Subscapularis nerve
What is action of deltoid
Anterior = flexion + pec major Middle = abduction Posterior = extension
What are the symptoms of calcific tendonitis
Deposits of calcium phosphate in any tendon- commonly rotator cuff
Painful abduction
Tender to palpate
Inflammation of supraspinatous
How do you Dx and Rx
X-ray will show calcification
Physio
ANalgesia
Steroid injection
What is Medial epicondylitis. ‘Golfer’s elbow’
Tendinopathy / degeneration of flexor muscles to medial epicondyle
What are the symptoms
Pain and tenderness over medial epicondyle
Worse on extension of elbow
Worse on wrist flexion / pronation
May have numb 4th + 5th fingers due to ulnar nerve
What is Lateral epicondylitis tennis elbow)
Tendinopathy / degeneration of extensor muscles to lateral epicondyle
What are the symptoms
Pain and tenderness over lateral epicondyle
Worse on flexion elbow (opposite to muscle inflamed)
Pain worse on resisted wrist extension
